Individual
MICHAEL L CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3031 S RUSSELL, SUITE 4, MISSOULA, MT 59801
(406) 721-8825
(406) 327-6702
Mailing address
3031 S RUSSELL, SUITE 4, MISSOULA, MT 59801
(406) 721-8825
(406) 327-6702
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
656
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160706
—
MT
01
—
40161
BC/BS
MT
Enumeration date
09/21/2006
Last updated
02/06/2008
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